Individual
DR. KSHAMA JAWALEKAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
150 E PONCE DE LEON AVE, SUITE 120, DECATUR, GA 30030-2543
(800) 998-5859
(404) 378-7460
Mailing address
150 E PONCE DE LEON AVE, SUITE 120, DECATUR, GA 30030-2543
(800) 998-5859
(404) 378-7460
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
12836
WV
2085R0001X
Radiation Oncology Physician
Primary
2008016361
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407989742
—
MO
05
—
176697001
—
AR
01
—
431560263
TRICARE WEST
—
01
—
P00817807
RAILROAD MEDICARE-CB9013
MO
Enumeration date
03/14/2007
Last updated
09/22/2010
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